Tuberculous meningitis (TBM), is common in those from countries where tuberculosis is common, and is also encountered in those with immune problems, such as AIDS. Despite advancement in vaccine development and chemoprophylaxis bacterial meningitis remains a major cause of death and neurological disabilities which can be prevented by rapid and accurate diagnosis with prompt treatment which is essential for good outcome (Carbonnelle, 2009). Viral meningitis is generally less severe and clears up without specific treatment. Viral ("aseptic") meningitis is serious but rarely fatal in people with normal immune systems. Usually, the symptoms last from 7 to 10 days and the patient recovers completely. Often, in www.intechopen.com Please use Adobe Acrobat Reader to read this book chapter for free. Just open this same document with Adobe Reader. If you do not have it, you can download it here. You can freely access the chapter at the Web Viewer here. Meningitis 186 early phases of viral meningitis and bacterial meningitis, the symptoms are almost similar (Carbonnelle, 2009). Fungal meningitis is rare, but can be life threatening. Although anyone can get fungal meningitis, people at higher risk are those who have AIDS, leukemia, or other forms of immunodeficiency. The most common cause of fungal meningitis in HIV, is Cryptococcus spp. In the last two decades, more elaborative use of intensive care units for serious medical disorders, advancements in transplant procedures and concomitant use of immunosuppressive therapies as well as the pandemic spread of HIV, etc. have increased the incidence of Central Nervous System (CNS) fungal infections which present with various clinical syndromes: meningitis commonly. The clinical picture may mimic TBM and therefore, needs careful evaluation. The CNS mycoses carry higher risks of morbidity and mortality as compared to other infective processes and therefore promptly require precise diagnosis and appropriate medical and/or surgical management strategies to optimize the outcome (Raman Sharma, 2010). Chemical meningitis can develop after neurosurgical procedures and can be differentiated from bacterial meningitis by Cerebrospinal fluid (CSF) glucose levels and CSF White Blood Cell (WBC) values. The causes of non-infectious meningitis include cancers, systemic lupus erythematosus, drug induced, head trauma, brain surgery etc. Please use Adobe Acrobat Reader to read this book chapter for free. Just open this same document with Adobe Reader. If you do not have it, you can download it here. You can freely access the chapter at the Web Viewer here.
Background:Ventilator-associated pneumonia (VAP) is a common complication with endotracheal intubation. The occurrence of VAP results in significant mortality and morbidity. Earlier studies have shown reduction in the incidence of VAP with subglottic secretion drainage. The incidence of VAP in neurologically injured patients is higher and can impact the neurological outcome. This study aimed to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurologically ill patients and its impact on clinical outcome.Methods:Fifty-four patients with neurological illnesses aged ≥18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. All the VAP preventive measures were similar between two groups except for the difference in type of tube.Results:The data of 50 patients were analyzed. The incidence of clinical VAP was 20% in SETT group and 12% in SACETT group; (P = 0.70). The incidence of microbiological VAP was higher in the SETT group (52%) as compared to SACETT group (44%) but not statistically significant; (P = 0.78). There was no difference between the two groups for measured outcomes such as duration of intubation, mechanical ventilation, and Intensive Care Unit stay.Conclusions:In this pilot study in neurological population, a there was no significant difference in incidence of clinical and microbiological VAP was seen between SETT and SACETT, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation.
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